Neurorehabilitation research provides hope, quality of life

Patient Emmett Johnson works with Scott Hutchison, an occupational and physical therapist, who conducts research in the Center for Rehabilitation Research in Neurological Conditions. photos by Brian Gottleib, College of Health Professions

Most people would consider the thought of waking up to find they can’t walk, speak or move their hands a nightmare. But for the 54 million Americans who live with a neurological disability caused by damage to the brain, spinal cord or peripheral nervous system, that is exactly how each day begins.Many of these people suffer impaired vision, paralysis and a significant loss of balance. Others have memory deficits, difficulty processing information and expressing their thoughts.

Most who suffer are desperate for help and neurorehabilitation researchers at MUSC aim to answer their call.

“Currently, there are no cures for the majority of neurological diseases or conditions that cause disability. However, here at South Carolina’s only dedicated neurorehabilitation research center we can provide innovative treatments that have the potential to significantly reduce the disabilities associated with neurological conditions and improve an individual’s function and quality of life,” said Lisa Saladin, Ph.D., dean of the College of Health Professions.

Providing innovative solutions is the driving mission for James Krause, Ph.D., director of the Center for Rehabilitation Research in Neurological Conditions, and his team. By bringing together leading clinicians and researchers in stroke, spinal cord injury, cerebral palsy and other neurological conditions, people with these disabilities are offered hope for the future.

People tend to take movement and normal body functions for granted. Patients who have lost basic abilities long to return to the life they lived prior to their neurological event, a time when their routines were easy and came to them naturally. However, for most people, medical treatment alone will not significantly improve their movement and function. That requires intense rehabilitation.

Steve Kautz, Ph.D., chairman of the Department of Health Sciences and Research and associate director of the Center for Rehabilitation Research in Neurological Conditions, leads a team of innovative neurorehabilitation researchers who are working to help these individuals. Their ultimate goal is to develop novel interventions that will increase a person’s ability to walk, use their arms, regain their balance and return to their lives and careers.

For most of the 20th century, the consensus among neuroscientists was that the structure of the brain was relatively permanent after early childhood. It’s only been over the last 15 years that this widely-held belief has been overturned as new research has revealed that the brain remains able to essentially reorganize itself when confronted with new challenges, regardless of age. This is referred to as neuroplasticity. Under normal circumstances, neuroplasticity allows our brain to adapt throughout life, but it is particularly important after brain injury from stroke, accidents and congenital disorders.

Evidence suggests that the brain, when given the right set of exercises or therapies, can actually reshape itself to become more efficient. This revelation has had far-reaching consequences and MUSC’s neurorehabilitation researchers are continuously discovering new ways for leveraging neuroplasticity to improve the brain’s health and performance.

Now that it is known that the brain and nervous system are indeed able to form new pathways and connections, it stands to reason that targeted rehabilitation can enhance neuroplasticity. To that end, designing individually tailored treatment plans for patients is critical.

The reputation of the center has gained national recognition because of innovative methods, renowned faculty and cutting–edge technologies.

For instance, playing a virtual reality video game might not be the first thing that comes to mind when you think of rehabilitation, but when you walk into one of the center’s four recently built rehabilitation labs, it is immediately clear there is nothing conceptual about the work being done there.

These labs were designed to document precise measurements so appropriate treatments and progress can be analyzed after an intervention and the most pressing question can be answered: Did the patient improve?

In answer to this question, Kautz suggested that the measurement and intervention framework currently being used by clinicians was insufficient in terms of being able to determine a post-stroke patient’s individual deficits as it related to their recovery and designing the most effective intervention for them.

The team moved to a more relevant model where the status of a patient’s motor–control system would first be assessed and his or her personal deficits identified. Subsequently, specific treatments would be used to target those deficits and finally, an assessment of the patient’s pre- and post-treatment condition would be made through quantitative measurements.

“This model allows us to determine what measurements we need for clinical and theoretical decision making,” said Kautz. “How can we possibly have specific interventions if we don’t have specific measures? This is critical to developing efficacious interventions.”

Kautz believes the answers will be found in the work being conducted in the college’s four rehab laboratories.

All four labs are custom-designed with specific cutting-edge instrumentation, specialized instrumented measurement equipment, specialized sensor systems and diagnostic machines. There’s even a $200,000 system that integrates an overhead body weight support system, harnesses and a treadmill. It allows safe and proper movement over ground and over the treadmill while a portion of body weight is unloaded to reduce the walking demands for participants with impairments.

Additionally, research participants in the locomotor energetics and assessment lab, for instance, have LED sensors strategically placed on their bodies to track where the subjects are in space and allow for a complete picture of how they walk and move their limbs to combine with measurement of their muscle activity and oxygen consumption from additional sensors.

“We have to know how to rehab people in their current state, after an event,” Kautz said. “The specifics of how someone walks, how their nervous system behaves, what changes are taking place ultimately lead us to the best therapies for each patient.”

Researchers are pursuing this approach in an effort to personalize therapy to individual patients. “So there can’t be a one-size-fits-all approach to therapy. It has to be personalized,” said Michelle Woodbury, Ph.D., center investigator.

Therapist Scott Hutchison works with rehab patient Cynthia Gant with therapy exercises at the Center for Rehabilitation Research.

Regaining arm and hand flexibility is very difficult and recent studies show it takes 36,000 movement repetitions to see improvement. Woodbury and her team have proved that after a stroke, arm motor–skill can recover if the proper rehabilitation program provides an adequate "dose" of repetitive movement practice.

She and her team developed, tested and licensed a prototype virtual environment (VE) to give stroke survivors the repetitive regimen they needed for physical improvement. This interactive system helps stroke patients improve their upper-limb motor functioning by recognizing and interpreting the user’s movements, assessing their rehabilitation progress, and adjusting the level of difficulty for subsequent therapy sessions.

Because of its non-traditional qualities, patients enjoy the virtual-gaming experience and have fun making progress while the highly individualized program helps them regain lost strength and motor skills in the process. Patients were able to reach out and grab objects more easily after only two weeks of playing the interactive games.

Patients are elated to regain any movement in limbs once thought useless.

“They basically taught me how to walk again,” said Carl Klele, a research participant and Vietnam veteran who suffered a spinal cord injury when his helicopter crashed in the rice paddies of Vietnam during the war. After decades of frustration and hopelessness, Klele walks independently and has a new lease on life thanks to rehabilitation.“I thought I was too old and had let it go too long. But what those people did for me was a miracle.”